Title page for ETD etd-06202011-143341


Document Type Master's Dissertation
Author Human, Anri
Email anrihuman@gmail.com
URN etd-06202011-143341
Document Title Best current evidence on chest physiotherapy in non-ventilated paediatric patients (0 to 24 months) with bronchiolitis : a systematic review
Degree MPhysT
Department Physiotherapy
Supervisor
Advisor Name Title
Ms K Mostert-Wentzel Supervisor
Keywords
  • virale brongiolitis
  • pulmonÍre postural dreinasie
  • respiratoriese sinsitium virus infeksies
  • respiratory infections
  • pulmonary postural drainage
  • respiratoriese terapie
  • respiratory drainage
  • respiratory syncytials virus infections
  • respiratory bronchioles
  • physical therapy techniques
  • viral bronchiolitis
  • physical therapy modalities
  • respiratoriese brongioli
  • respiratory tract infections
  • respiratory therapy
  • respiratoriese infeksies
  • respiratoriese lugweg infeksies
  • fisioterapie modaliteite
  • fisioterapie tegnieke
  • respiratoriese dreinasie
Date 2011-04-15
Availability unrestricted
Abstract

Title

Best current evidence on chest physiotherapy in non-ventilated paediatric patients (0 to 24 months) with bronchiolitis: a systematic review.

Purpose

To determine the current scientific evidence for using three chest physiotherapy modalities namely percussion, postural drainage and suctioning in paediatric patients (0 to 24 months).

Relevance

The field of cardiopulmonary physiotherapy seems to be a neglected area in physiotherapy, with a subsequently limited evidence base. The author observed that in various clinical settings physiotherapists tend to administer routine chest physiotherapy to paediatric patients with bronchiolitis. Findings from this study may assist physiotherapists in their choice of effective treatment options.

Sources

The following databases were searched for evidence:

African Health Line, CINAHL, Cochrane, Ebsco Host, Emerald Host, UP E-theses/dissertations, PEDro, Medline Ovid, Sabinet, Science Direct, Up To Date.

Methodology

This was a systematic review. The databases were reviewed by making use of a specified search strategy customised for each database. Keywords were: physiotherapy/physical therapy, bronchiolitis and paediatric/pediatric in combination with percussion, postural drainage and suction. The search yielded 10,016 study titles. Studies were chosen from the population of studies using pre-set inclusion and exclusion criteria. These criteria were applied to the titles, abstracts and full-text articles as appropriate. Five full text-articles were appraised and based on the scores from the appraisal three were included in the final sample.

Data analysis

Appraisal instruments from the National Health System Critical Appraisal Skills Programme (NHS CASP) and the PEDro scale (for randomised controlled trials) were used to evaluate and score the sample. Scoring was done independently by two researchers, and agreement reached through negotiation. The evidence was synthesised and graded according to the Sackett hierarchy of evidence.

Results

Owing to the heterogeneity of the sample, and the nature of results reported, a meta-analysis was not possible.

Results from this study reveal that there is no evidence to support routine chest physiotherapy in uncomplicated viral bronchiolitis amongst the paediatric population. Chest physiotherapy does not decrease length of hospital stay, oxygen requirements or clinical scores indicating distress/morbidity. However, with secondary bacterial respiratory infections, chest physiotherapy may be indicated, depending on the assessment of each individual patient.

Conclusion

Percussion, postural drainage and suctioning are not effective in the management of bronchiolitis in children, newborn to 24 months old, except in individually assessed cases with secondary bacterial infection. In this subset, physiotherapy must be customised to the patient. Therefore routine physiotherapy is not indicated.

Implications

Chest physiotherapy should be based on a complete evaluation and on clinical merit, as well as on evidence and patient preference. Education of physiotherapy students at universities as well as doctors regarding the current evidence for chest physiotherapy in paediatric bronchiolitis is essential. Doctors and clinicians need to be made aware that routine chest physiotherapy for paediatric patients with bronchiolitis should not be prescribed.

AFRIKAANS :

Titel

Die beste huidige bewyse aangaande longfistioterapie vir non geventileerde pediatriese pasiŽnte (0 tot 24 maande) met brongiolitis: 'n sistematiese oorsig.

Doel

Om huidige wetenskaplike bewyse vir die gebruik van drie long fisioterapietegnieke naamlik beklopping, posturale dreinasie en suiging in pediatriese pasiŽnte (0 tot 24 maande) te bepaal.

Toepaslikheid

Die veld van pediatriese fisioterapie blyk 'n verwaarloosde area van navorsing te wees, met gevolglik beperkte bewysbasis. Die navorser het ondervind dat fisioterapeute dikwels in kliniese praktyk roetine longfisioterapie in pediatriese pasiŽnte met brongiolitis toepas. Bewyslewering vanuit hierdie studie kan fisioterapeute help met die keuse van effektiewe behandelingsprosedures.

Bronne

Die volgende databasisse is deursoek vir bewyse: African Health Line, CINAHL, Cochrane, Ebsco Host, Emerald Host, UP e-theses and dissertations, PEDro, Medline, Sabinet, Science Direct en Up To Date. Die soektog het 10,016 titels gelewer.

Metode

'n Sistematiese oorsig van die data is uitgevoer deur 'n gespesifiseerde soekstrategie, aangepas vir elke databasis, te volg. Sleutelwoorde was: ďphysiotherapy/physical therapyĒ, ďbronchiolitisĒ and ďpaediatric/pediatricĒ in kombinasie met ďpercussionĒ, ďpostural drainageĒ and ďsuctionĒ. Voorafbepaalde insluitings- en uitsluitingskriteria is toegepas op titels, abstrakte en artikels soos toepaslik.

Data analise

Evalueringsinstrumente van die ďNational Health System Critical Appraisal Skills programmeĒ (NHS CASP) asook die PEDro skaal (ewekansige gekontroleerde eksperiment) is gebruik vir evaluasie van en puntetoedeling vir die verkose studies. Die puntetoekenning is onafhanklik deur twee navorsers gedoen en konsensus is bereik deur onderhandeling. Die inligting verkry is gesintetiseer en gegradeer aan die hand van die Sackett hiŽrargie van bewyse. As gevolg van die heterogeniteit van die ingeslote studies en die aard van die resultate was 'n meta-analise nie moontlik nie.

Resultate

Die studie het bevind dat daar geen bewyse is vir roetine borskasfisioterapie van ongekompliseerde akute virale pediatriese brongiolitis nie. Borskasfisioterapie verminder nie die duur van hospitaalverblyf, suurstofbehoeftes of die kliniese respiratoriese aanduiding van stres in die pasiŽnte nie. In die geval van sekondÍre bakteriŽle respiratoriese infeksies mag borskasfisoterapie egter geindikeerd wees, afhangend van die evaluasie van elke individuele pasiŽnt.

Gevolgtrekking

Beklopping, posturale dreinasie, en suiging as roetine behandeling is nie effektief in die behandeling van brongiolitis in pasgebore tot 24 maand oue pasiŽnte nie, behalwe individuele gevalle met sekondÍre bakteriŽle infeksies. In hierdie spesifieke subgroep moet borskasfisioterapie aangepas word vir pasiŽnt. Roetine fisioterapie is dus nie aangedui nie.

Implikasies

Borskasfisioterapie moet gebasseer wees op 'n volledige evaluasie en kliniese meriete, asook bewyslewering en die pasiŽnt se voorkeure. Opleiding van fisioterapie studente by universiteite, asook dokters aangaande die huidige bewyslewering vir borskasfisioterapie in pediatriese brongiolitis is belangrik. Dokters en klinici moet bewus gemaak word dat roetine borskasfisioterapie vir pediatriese brongiolitis pasiŽnte nie voorgeskryf moet word nie.

Additional information available on a CD stored at the Merensky Library.

© 2011, University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria.

Please cite as follows:

Human, A 2011, Best current evidence on chest physiotherapy in non-ventilated paediatric patients (0 to 24 months) with bronchiolitis : a systematic review, MPhysT dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd-06202011-143341/ >

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